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Highlights • Mean HBA1c in diabetic patients increased by 0.51% in immediate post lock down period due to COVID 19. • Increased mean HBA1c may significantly increase the annual incidences of complications related to diabetes. • With early identification and multidisciplinary approach which is patient centric good glycemic control can be achieved back. • By achieving good glycemic control, the predicted annual percentage increase in complication rate can be reduced., Background and aims Diabetes is a chronic metabolic condition characterized by hyperglycemia and is associated with several complications. Prevalence of Diabetes in adult population in India ranges from 10.9 to 14.2% in urban area and 3.0–7.8% in rural area. Glycemic control is an important factor in preventing the complications associated with diabetes. HBA1c is the indicator of long-term glycemic control and slight variation in it significantly alters the risk of diabetic complications. Thus, the aim of this study was to study the change in HBA1c levels due to lock down in patients with diabetes. Methods 307 patients with diabetes who had attended our endocrine OPD in last 3 months before nationwide 68 days lockdown from 24 March 2020 to 31 May 2020, and had recent HBA1c report in past and willing to participate were included in the study after informed consent from 2nd June 2020 to 14th June 2020 when first phase of Unlock started, to identify the change in HBA1c levels during the lockdown period in our patients with diabetes. Results The patients were aged between 25–69 years and male to female ratio was 181:126 (1.44: 1). The mean age and mean duration of diabetes in our patients was 55.68 years and 7.95 years respectively. Increment of 0.51% was seen in mean HBA1c levels in our patient from 7.92% mean pre-lockdown HBA1c to mean of 8.43% after release of lock down. Conclusion Glycemic control got deranged during lockdown period with significant increase of mean HBA1c by 0.51% in immediate post lock down period which may significantly increase the annual incidence of complications related to diabetes.

Background and aims Diabetes is a chronic metabolic condition characterized with hyperglycemia and associated with several complications. Glycemic control is important factor in preventing the complications associated with diabetes. Pillars for good glycemic control are good life style modification with proper medication under medical guidance. The aim of this study was to study the effect of lock down on glycemic control in diabetic patients and possible factor responsible for this. Material and methods – Out of 407 only 143 diabetic patients who attended the our endocrine OPD in last 3 months who had good glycemic control in past without any chronic complication and willing to participate were included in study. They were advised for the self-monitoring of blood glucose for identifying the glycemic control and with questionnaire designed possible factor was identified during the lockdown period. Results – The patients were aged between 18 and 65 years with mean age of 54.68 years and male to female ratio was 91:52.56 (39.16%) patients reported worsening of hyperglycemia and requiring addition of medications for control of blood glucose and 3 (2.09%) patients reported hypoglycemic events and medications were stepped down. Psychological stress was most common factor worsening of hyperglycemia followed by change in diet and exercise., Highlights • Overall Glycemic control got deranged in diabetic patients during the lockdown period. • Lifestyle changes and psychological stress identified as possible factors responsible for derangement of glycemic control. • Multidisciplinary approach is required which is patient centric for achieving good glycemic control.

Introduction: Pheochromocytoma, a rare tumor arising in the adrenal medulla, It is a catecholamineproducing tumor. It’s prevalence in hypertensive patients is 0.2%, and 0.002% of pregnancies. Its clinical presentation is typically hallmarked by sustained or intermittent hypertension associated with paroxysmal symptoms. Pheochromocytoma should also be considered if a patient has labile hypertension, hypertension resistant to treat by antihypertensive therapy, or paroxysmal symptoms (“spells”). Correct diagnosis is essential as surgical resection of the tumor dramatically reverses the clinical symptoms and may cure the hypertension. Pheochromocytoma with clinical presentation was earliest reported in 1926 when Cesar Roux in Switzerland and Charles H. Mayoin the United States successfully removed pheochromocytomas to cure the catecholamine-associated symptom complex. During pregnancy the clinical presentations can be easily confused with severe pre-eclampsia. The presentation of uncontrolled hypertension and headache not responding to medication may be misleading diagnose. It can be even more challenging if phechromocytoma is undiagnosed. This adrenal tumor also increases the risk of adverse pregnancy outcome like abortion, still birth or pre term delivery. We report this case from People’s College of Medical Science & Research Centre a case of Pheochromocytoma with Pregnancy. Keywords: Pheochromocytoma, prevalence in hypertensive.

Cardiovascular diseases (CVD) risk in people with type 2 diabetes mellitus (T2DM) is two to four folds higher than in individuals without T2DM. Insulin therapy was speculated to be atherogenic- thereby aggravating CVD risk years ago. However, cardiovascular outcome trials (CVOTs) such as the Outcome Reduction with Initial Glargine Intervention (ORIGIN), and its extended follow-up study - ORIGIN and Legacy Effects (ORIGINALE) conclusively established the long-term cardiovascular (CV) safety of basal insulin, such as insulin glargine 100 U/mL (Gla-100). Moreover, these studies hinted at the possible benefits of early insulin therapy-including stalling the progression of diabetes with minimal weight gain and hypoglycemia risk. This review highlights the background developments which led to the ORIGIN trial. Additionally, it also dwells on the critical insights to emerge from this trial pertaining to the CV safety of basal insulin Gla-100 in high CV risk individuals with T2DM.

Oral antidiabetic failure (OAD failure) is a term which is used frequently in clinical practice. There is no uniformly accepted definition, however, for this term. This communication describes the concept of OAD failure, and develops a working definition for the same. The definition uses resistant hypertension as an example, and assesses the relative role of various classes of OADs, lifestyle modification, secondary causes of hyperglycaemia, and symptomatology in diabetes praxis. It utilizes these concepts to build a definition of OAD failure which states: OAD failure is defined as a clinical situation where HbA1c remains above goal, despite concurrent use of optimum dose of three oral glucose lowering drugs of different classes, one of which should be metformin and the second, preferably a sulfonylurea, provided adequate diet and exercise have been followed, and comorbid conditions causing hyperglycaemia ruled out. OAD failure may also be defined in patients who have symptoms suggestive of insulinopenia (osmotic symptoms, weight loss), and uncontrolled glycaemia (plasma glucose300mg %), in spite of using triple OAD therapy.

Diabetic retinopathy (DR) is a complication of long-term diabetes mellitus (DM). Over the last 2 decades lot of work has been on early diagnosis of DR and screening programs have been designed to help the masses. Large numbers of clinical studies have been done for patients of diabetes and DR wherein the role of blood sugar control, metabolic control, role of oral medicines for DR, role of imaging, fluorescein angiography, and retinal photocoagulation has been studied. Newer treatment modalities are being devised and studied for better patient care. We discuss these issues in our review highlight and newer advances over the last few years.

Reversible quadriplegia is a relatively rare condition. Here, the authors describe an interesting case where a patient, three and a half months after her delivery, presented with fever and abdominal pain. She further developed hyponatremia, became delirious, and then developed quadriplegia.

We describe a family in which parents had consanguinity, being children of real sisters. They had given birth to five children. In their family, children remained healthy from birth to pre-school age and then started having symptoms around the age of 5 years and two of them succumbed to this illness. Polyglandular autoimmune syndrome Type-1 is a rare sporadic autosomal recessive disease. It is characterized by the existence of two or more endocrinal disorders. Patients may require lifelong hormone replacement therapy for survival.

A 20-year-old man presented to our outpatient with a history of diarrhoea since the last 40 days. Stools were 3–4 times/day, watery and not containing mucous or blood. Patient had arthritis involving hips, knees and shoulders intermittently for 6 years which flared up again after his recent episodes of diarrhoea. He also observed skin lesions that were first noted on the scalp about 5 years ago and were now present on trunk, abdomen, thighs and soles since the last 3 months. Patient had recently also noted that he had puffiness around his eyes and swollen feet. He …

Despite the rising number of patients with diabetes and hypertension in India, there is a dearth of nationwide, comprehensive prevalence data on these diseases. Our study aimed at collecting data on the prevalence of diabetes and hypertension and the underlying risk factors in various outpatient facilities throughout India.This cross-sectional study was planned to be conducted in 10 Indian states, one state at a time. It was targeted to enroll about 2,000 patients from 100 centers in each state. Each center enrolled the first 10 patients (≥18 years of age, not pregnant, signed consent) per day on two consecutive days. "Diabetes" and "hypertension" were defined by the 2008 American Diabetes Association and the Joint National Committee's 7(th) Report guidelines, respectively. Patient data (demographics, lifestyle factors, medical history, and laboratory diagnostic results) were collected and analyzed.During 2009-2010, in total, 15,662 eligible patients (54.8% males; mean age, 48.9±13.9 years) from eight states were enrolled. Diabetes was prevalent in 5,427 (34.7%) patients, and 7,212 (46.0%) patients had hypertension. Diabetes and hypertension were coexistent in 3,227 (20.6%) patients. Among those whose disease status was not known at enrollment, 7.2% (793 of 11,028) and 22.2% (2,408 of 10,858) patients were newly diagnosed with diabetes and hypertension, respectively; additionally, 18.4% (2,031 of 11,028) were classified as having prediabetes and 60.1% (6,521 of 10,858) as having prehypertension. A positive association (P0.05) was observed between diabetes/hypertension and age, familial history of either, a medical history of cardiovascular disorders, alcohol consumption, and diet.Our study demonstrates that the substantial burden of diabetes and hypertension is on the rise in India. Patient awareness and timely diagnosis and intervention hold the key to limiting this twin epidemic.

Des enfants de 9 ans de Kurukshetra (Nord de l'Inde) ont ete evalues a partir de Matrices Progressives, d'un test de vocabulaire et de quatre tests musicaux. La circonference, la taille et le poids de leur tete ont egalement ete mesures. Il existe des correlations entre les mesures cognitives et la circonference de la tete , mais seule la correlation avec les Matrices Progressives est significative. Les resultats posent qu'un cerveau large constitue un avantage pour la resolution de problemes complexes (Matrices) mais est moins avantageux pour la resolution de tests musicaux simples. D'un point de vue evolutionniste, le developpement d'un cerveau large serait en rapport avec la resolution de tâches difficiles

An 80-year-old man presented with abdominal discomfort, constipation, malaise, loss of appetite and weight loss of 6 months duration. On local examination, there was a hyperpigmented lesion (17×13 mm) (figure 1) on the sole of the right heel which was asymmetrical, had irregular borders and colour variegation. It had central ulceration. Also, there were satellite lesions around it. On systemic examination, there was hepatomegaly. The striking finding was a bunch of matted lymph nodes in the right inguinal region (figure 2). Figure 1 Sole hyperpigmented …

We report a recent diabetic who presented with hyperglycemic, hyperosmolar, non ketotic state with coma and multiple cranial nerve palsies due to an associated previously undetected sinus infection. This is a classic case revisited purely for its educational value in terms of clinical photographs, tissue biopsy and imaging findings. These findings reiterate the devastating neurological consequences of fungal sinusitis in diabetic patients.

Squamous cell carcinomas in the gastrointestinal tract are known to occur in oro-pharynx, esophagus and anal canal. Gastric squamous cell carcinoma is a rare epithelial tumour. Surgical treatment is the same as that for an adenocarcinoma, though prognosis is probably worse.

A 45 year old hypertensive patient presented to the emergency medical room (EMR) with sudden onset of severe headache, episode of vomiting, visual loss and confusion. A C.T scan and MRI brain was done revealing a large hematoma in the region of posterior part of left thalamus. The patient was disoriented in time, place and had right visual field hemianopia. The headache and higher functions became normal with control of intracranial pressure and supportive therapy. There were no motor or sensory symptoms or signs. This case is unique as a large thalamic hematoma presented with only visual field deficit and no sensory or motor system affection.

Nutrition is an integral part of science, medicine, and life in general. The Bhagavad Gita, an ancient religious scripture of India, discusses nutrition, metabolism, and endocrinology in surprisingly great detail. This paper highlights aspects of these subjects that are covered in this book, trying to achieve concordance between ancient wisdom and modern science. It proposes an overlap between the metabolic classification mentioned in the Gita [sattvika, rajsika, tamsika] and endocrine or metabolic diseases recognized today

Background and Objective: The primary objective of this study is to find out if testing ankle reflex (AR) alone is an effective screening tool for diabetic peripheral neuropathy and the secondary objective of this study is to compare its sensitivity and specificity with biothesiometer vibration perception threshold (VPT), which is the gold standard. Materials and Methods: A total of 450 patients with diabetes mellitus attending endocrine out-patient department from year 2012 January to 2013 July were included in this study. All patients underwent clinical assessment of AR compared with VPT by biothesiometer. Results: AR is sensitive (81.09%) specific (81.679%) with diagnostic accuracy of (81.22%) and agreement between biothesiometer and AR is significant (κ = 0.538 P < 0.0001). Conclusion: AR is at par the gold standard that is biothesiometer VPT.

A 49-year-old male, hypertensive for 2 years presented with recurrent renal colic of 6 months duration. x-Ray abdomen and intravenous pyelogram showed multiple stones in both kidneys and ureters resembling beads in a necklace (figure 1A and B) with hydronephrotic changes. His renal function tests reflected mild renal insufficiency (serum urea 55.5 mg/dl, serum creatinine 2.5 mg/dl) serum uric acid was 8.9 mg/dl. Serum calcium was 13.0 mg/dl and serum phosphate 2.9 mg/dl. Intact plasma parathyroid hormone (PTH) was ordered which came 375.1 pg/ml against normal of 14–72 pg/ml. There was a small, firm palpable nodule in the left lobe of thyroid measuring 1.5 …

A 37-year-old man developed low grade fever during January 2007 for which he received symptomatic treatment following which he gradually noticed a tremor of his left hand that made it difficult for him to write and even to put his signature. The tremors gradually progressed to his arms and trunk and he also developed a nodding movement in his head. There was progressive slowness in walking with a tendency to fall on either side. On examination in April 2007, he was noted to have a low frequency tremor at rest varying with posture and …

A 48-year-old Filipino female presented with unilateral acute onset painful red eye, blurred vision and yellow discharge. On examination she had a corrected visual acuity of 6/5 in the right eye and 6/18 in the left eye. There was a left-sided periorbital swelling, with chemosis involving the bulbar conjunctiva on the temporal aspect. Ocular motility showed limitation of left-sided abduction with mild limitation of laevoelevation and laevodepression. She was afebrile and systemic examination was unremarkable. Medical history included diagnosis of Crohn's disease since the age of 20. She was on oral mesalamine 1 g for mildly active colitis. Full blood count was normal but erythrocyte sedimentation rate and C reactive protein were raised. Blood culture and conjunctival swab were negative. Contrast-enhanced CT scan demonstrated enlargement of the lacrimal gland. She was managed conservatively with acetaminophen and codeine for pain and swelling. She recovered completely in 2 weeks with no sequelae.